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Thursday, 21 July 2011

Curcumin and the Drugs Industry

Looking through some of the previous articles on this site you’ll notice frequent mentions of curcumin. Of the many food-based anti-cancer agents, this extract from turmeric (the yellow spice used in curry), is one that generates a lot of scientific interest. Curcumin has anti-oxidant, anti-inflammatory and a wide range of anti-cancer properties. It is cheap, non-toxic and has been used as a traditional medicine for hundreds of years. In terms of research, it has plenty of in vitro and in vivo evidence against a wide range of different cancers. What’s more, there have been early stage clinical trials that show that even at high doses curcumin is non-toxic. There are lots of positives about curcumin, but there are also some significant issues. First and most obvious is that it suffers from very low levels of bioavailability. In other words it takes a lot of curcumin to generate even low levels in the blood stream. Secondly, most of the in vitro and in vivo studies use the raw material, but when we take it orally it gets metabolised as we digest it, so it’s not pure curcumin that circulates in the body (though in the digestive tract things are different, obviously). These issues are not unique to curcumin by a long shot, and they are discussed in more detail in the articles on How To Read A Cancer Paper (here and here).

Even with those caveats, curcumin is an interesting substance that bears closer investigation. But, given the urgency with which we want the research to proceed, you have to ask yourself why such a positive drug candidate has not moved further. Where are the large scale trials in cancer patients? Why isn’t curcumin part of the everyday armoury that we use against cancer?

The reason that is normally given is that the drug companies are not interested. Curcumin is a natural substance, it cannot be patented. For a drug company this means that there is no way they can make any money out of curcumin. If they put the investment into research, including the funding of clinical trials, and come up with positive results, then anyone and everyone can take advantage of it – there’s no way they can recoup the investment. Again, this isn’t unique to curcumin, there are plenty of other interesting substances that suffer the same problem – quercetin, melatonin, aspirin etc. This isn’t a conspiracy theory – it’s not that the drug companies want to stop curcumin being developed, it’s just that they can’t make any money out of it. They exist to make money, and they will do this in the way that makes most commercial sense to them.

There are a number of points that are worth making about this.

The first, and to my mind most important, is that we should not be waiting for the drug companies to take curcumin (or other similar substances) forward to clinical use. Drug companies are responsible, ultimately, to their shareholders (and very often that’s our pension and insurance funds...), they do not exist primarily for philanthropic reasons. They do lots of good, we would be in a much worse state if it were not for the drug companies investing in research and development of new drugs, but they do this to make profits not to make themselves feel good about themselves. I have no problem with any of that.

In contrast, governments should ultimately be responsible to us, as citizens. We pay plenty of money in taxes, and the state invests in medical research and development as well. All Western governments are involved to some degree in ‘the war against cancer’ – the National Institutes of Health in the US, and the Medical Research Council in the UK, for example, have huge budgets. We should be applying pressure to these bodies to do the research we need into curcumin. As tax-payers and citizens we need to apply political pressure to change the way cancer research is conducted. There are models for this already – look at how political pressure was applied when HIV/AIDS was at the top of the news. We should demand the same responsiveness to the needs of cancer patients.

A second point to make here is that the regulatory frameworks in place make drug research and development a nightmare. The costs involved in running clinical trials are huge, and the rules in place make it difficult for even small trials to take place. It’s worth remembering that common drugs like penicillin and aspirin would most likely have never made it through today’s rules and regulations. How many treatments are being killed through the brain-dead application of overly restrictive rules and regulations?

Finally, we ought to remember that the low cost of curcumin should make it attractive to poorer governments in developing countries. Perhaps there’s room here for some of our aid agencies to get involved in looking at clinical trials in these countries.

In any case, it seems to me that spending our time attacking the drugs companies is self-defeating and crucially misses the one avenue that should be open to us to force some change for the better.

I will be coming back to this topic again. There are good things being done in cancer research, but the pace is painfully slow and it’s clear that we, as patients and supporters, need to have more input into the process.